Circulation: Arrhythmia and Electrophysiology

LETTER TO THE EDITOR

Letter by Sepehri Shamloo et al Regarding Article,
“Atrial Fibrillation Catheter Ablation Improves
1-Year Follow-Up Cognitive Function, Especially
in Patients with Impaired Cognitive Function”

To the Editor: Alireza Sepehri Shamloo,

The term cognitive function in the context of cardiac arrhythmias was first in- MD
troduced 30 years ago when evidence of cognitive impairment was reported in Nikolaos Dagres, MD
patients with chronic atrial fibrillation (AF). During the last decades, the topic of Gerhard Hindricks, MD
cognitive function assessment in AF patients has emerged as a hot topic in the field
of electrophysiology; >50 studies have investigated the relationship between these
2 significant public health concerns so far.1
The recently published study conducted by Jin et al2 is groundbreaking and not
only confirms findings previously reported by Bunch et al3 about the positive im-
pact of AF ablation on cognitive function but also emphasizes the importance of
considering patient-centered outcomes as end points in clinical trials. During the
last few decades, hundreds of studies in the field of cardiac arrhythmias have in-
vestigated the impact of different therapeutic strategies on major clinical variables
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including bleeding, stroke, arrhythmia recurrence, and mortality; and a number of

them have covered the psychocognitive status as main outcomes. We think that
the findings of this current study call to attention the importance of including
patient-centered outcomes and also patient-reported outcomes as end points in
clinical trials.
Currently, management of cognitive dysfunction and controlling the global bur-
den of dementia is one of the top public health priorities designated by the World
Health Organization. Moreover, we should not forget that the adherence of treat-
ment and medication intake might be adversely affected by cognitive dysfunction,
thereby negatively influencing outcomes and therapy efficiency in the patients suf-
fering from arrhythmias.1 Although more investigations are required to better de-
fine the impact of AF ablation on cognitive status, the recent findings of Jin et al,
in conjunction with other studies might be an indication that ablation can improve
depression and cognitive function.3–5 This, if supported by further studies, might
ultimately lead to the question whether it is time to consider psychocognitive im-
pairments as new indications for AF catheter ablation.
Although the current study by Jin et al helps us complete the puzzle of the as-
sociation between AF, the most common cardiac arrhythmia, and cognitive func-
tion, the question which arrhythmia is associated with a greater impairment of
cognitive function is still unanswered. Moreover, there is a still a lack of evidence
about the impact of different arrhythmia-related procedures, including medical
treatment, cardiac device implantation, ablation, or others on patients’ cognitive
function. So, when we face this question: Do we need further studies in this field?;
the answer is definitely yes. More specifically, the 2 main topics that in our opinion
need to be addressed more intensively are (1) the epidemiological understanding © 2019 American Heart Association, Inc.
of the association between arrhythmias and cognitive function and (2) the impact https://www.ahajournals.org/journal/
of arrhythmia-related therapies on cognitive function. circep

Circ Arrhythm Electrophysiol. 2019;12:e007822. DOI: 10.1161/CIRCEP.119.007822 October 2019 1

 Sepehri Shamloo et al; Letter to the Editor
ARTICLE INFORMATION
Affiliations
Department of Electrophysiology, Heart Center Leipzig at University of Leipzig,
Leipzig Heart Institute, Leipzig, Germany.
Disclosures
Drs Dagres and Hindricks report research grants from Abbott and Boston Scien-
tific to the institution without personal financial benefits. Dr Sepehri Shamloo
does not declare any conflict of interest.
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October 2019 2